Therapeutic Colonoscopy in Children: Endoscopic Snare Polypectomy and Juvenile Polyps

Abstract

Safety and efficacy of colonoscopic polypectomy without using general anesthesia in young children with juvenile polyps were studied. Between July 1987 and June 1993, seventy six colorectal polyps of up to 4.5cm diameter were removed by diathermy snare during 43 colonoscopic polypectomy sessions on 38 children aged from 6 months to 13 years (mean, 4.4 years). Thirty four children had single polyps. The remaining four children had more than two polyps. One of them was juvenile polyposis. General anesthesia was not used in any infant or child. In 31 (82%) patients, colonoscopic polypectomy was performed on an ambulatory basis. Most juvenile polyps (89%) occurred as a solitary lesion. In 76% of patients, polyps were located in the rectosigmoid region. Seventy nine percent of the polypectomized juvenile polyps were between 1 em and 3 em diameter in size. No complications related to medication, colonoscopy. or snare polypectomy were observed in any of the children. The major clinical manifestations of children with juvenile polyps were hematochezia (89%), abdominal pain (19%), mucoid stools or diarrhea (45%), and anemia (29%). These clinical symptoms disappeared soon after removal of polyps. In 18 of 33 patients with juvenile polyps, barium enema did not demonstrate any colonic polyps. More than 6 months' delay of diagnosis was noted in 40% of patients. Only 32% of patients were diagnosed to have juvenile polyps within 3 months from the onset of hematochezia. Sixteen patients (42%) were referred with a clinical impression of colon polyp. However, the remaining 22 patients had been treated before referral under various tentative diagnoses including dysentery-like infectious diarrhea (34%), anal fissure (11%), hemorrhoid (5%) and ulcerative colitis (5%). From the experience in the present study, it is concluded that colonoscopic snare polypectomy can be safely and effectively used at pediatric age for the treatment of juvenile polyps without using general anesthesia on an ambulatory basis.